發(fā)布時間：2018-08-26 20:02

【摘要】：目的:探討腫瘤型膝關(guān)節(jié)假體置換術(shù)中應用腓腸肌肌瓣進行軟組織修復與重建對于治療脛骨近端惡性腫瘤的臨床效果。方法:收集2004年-2012年之間于貴州醫(yī)科大學附院骨科診治的脛骨近端惡性骨腫瘤并行定制腫瘤型膝關(guān)節(jié)假體置換術(shù)的患者62人。按照其手術(shù)方式的不同,分為A、B兩組進行回顧性分析。A組為2004-2008年期間收治的30例,術(shù)中未行腓腸肌肌瓣轉(zhuǎn)移覆蓋。B組為2009-2012年期間收治的32例,術(shù)中行腓腸肌肌瓣轉(zhuǎn)移覆蓋。其中骨肉瘤45例,惡性骨巨細胞瘤9例,惡性纖維組織細胞瘤6例,軟骨肉瘤2例。Enneking分期IB期4例,IIA期18例,IIB期27例。兩組患者在年齡、性別及病理學類型方面差異無統(tǒng)計學意義。比較A、B兩組在術(shù)后并發(fā)癥發(fā)生率、復發(fā)率、死亡率、術(shù)后肢體功能評估等方面的差異。肢體功能評估包括客觀關(guān)節(jié)活動度測量和主觀Enneking評分兩方面。結(jié)果:全組62例患者中,男性35例(56.5%),女性27例(43.5%)。年齡15-60歲,平均29.24±8.46歲。在術(shù)后并發(fā)癥發(fā)生率方面,術(shù)后嚴格隨訪24-48個月,平均36.27±7.41月。術(shù)后發(fā)生并發(fā)癥為11例,B組僅出現(xiàn)2例(6.2%),明顯優(yōu)于A組9例術(shù)后并發(fā)癥(30%)。全組62例患者在隨訪期間4例患者出現(xiàn)了腫瘤復發(fā),復發(fā)率為6.5%。9例患者出現(xiàn)遠處轉(zhuǎn)移,該9例患者均因腫瘤轉(zhuǎn)移導致呼吸循環(huán)衰竭死亡,占14.5%。兩組在復發(fā)率及死亡率方面無顯著性差異。術(shù)后1年的功能評分方面,B組主觀Enneking評分28.44±1.76分,膝關(guān)節(jié)屈曲客觀測量可達135.63±7.80度,均明顯優(yōu)于A組(主觀Enneking評分26.70±1.24,膝關(guān)節(jié)屈曲客觀測量106.33±13.6度)。結(jié)論:定制腫瘤型膝關(guān)節(jié)假體置換術(shù)是治療脛骨近端惡性腫瘤的有效方式,其術(shù)中利用腓腸肌肌瓣修復其周圍軟組織,對于降低脛骨近端惡性腫瘤手術(shù)并發(fā)癥及有效發(fā)揮人工關(guān)節(jié)功能起著至關(guān)重要的作用,臨床上值得廣泛推廣和應用。
[Abstract]:Objective: to investigate the clinical effect of soft tissue reconstruction with gastrocnemius muscle flap in the treatment of proximal tibia malignant tumor. Methods: 62 patients with malignant tumor of proximal tibia treated by orthopaedics department of affiliated hospital of Guizhou Medical University from 2004 to 2012 were enrolled in this study. According to the different operation methods, the patients in group A were divided into two groups. Group A was treated from 2004 to 2008. Group B was treated with gastrocnemius muscle flap in 20092012, while group B was treated with gastrocnemius muscle flap in the period of 2009-2012. The patients in group A were treated with gastrocnemius muscle flap during the period of 2009-2012. Among them, 45 cases of osteosarcoma, 9 cases of malignant giant cell tumor of bone, 6 cases of malignant fibrous histiocytoma, 2 cases of chondrosarcoma. Enneking stage IB 4 cases, 18 cases of IIA stage II B, 27 cases. There was no significant difference in age, sex and pathological type between the two groups. The incidence of postoperative complications, recurrence rate, mortality rate and postoperative limb function evaluation were compared between the two groups. The evaluation of limb function includes objective joint motion measurement and subjective Enneking score. Results: of the 62 patients, 35 (56.5%) were male and 27 (43.5%) were female. The average age was 29.24 鹵8.46 years old. The postoperative complications were followed up for 24-48 months (mean 36.27 鹵7.41 months). There were only 2 cases (6.2%) with postoperative complications in group B, which was significantly better than that in group A (9 cases) (30%). The recurrence rate was 6.5.9 cases with distant metastasis. All the 9 patients died of respiratory and circulatory failure due to tumor metastasis, accounting for 14.5%. There was no significant difference in recurrence rate and mortality between the two groups. One year after operation, the subjective Enneking score of group B was 28.44 鹵1.76, and the objective measurement of knee flexion was 135.63 鹵7.80 degrees, which was significantly better than that of group A (subjective Enneking score 26.70 鹵1.24, knee flexion objective measurement 106.33 鹵13.6 degree). Conclusion: Tumor-type knee prosthesis replacement is an effective method for the treatment of proximal tibial malignant tumor. Gastrocnemius muscle flap is used to repair the surrounding soft tissue during the operation. It plays an important role in reducing the operative complications of proximal tibia malignant tumor and exerting the function of artificial joint effectively. It is worth popularizing and applying widely in clinic.
【學位授予單位】：貴州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R738.1

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